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Align ChoicePlus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Align ChoicePlus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Align ChoicePlus (PPO) in 2025, please refer to our full plan details page.
Align ChoicePlus (PPO) is a PPO plan offered by Sanford Health available for enrollment in 2025 to people living in South Dakota. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Align ChoicePlus (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Align ChoicePlus (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Align ChoicePlus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Align ChoicePlus (PPO)
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Drug Coverage
The Align ChoicePlus (PPO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay a $4 copay at preferred pharmacies and a $8 copay at standard pharmacies. For specialty tier drugs, there is no copay. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Align ChoicePlus (PPO) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a $175 copay for the first four days, with no copay for the following days, and outpatient services have copays ranging from $20 to $400. The plan includes coverage for primary care, preventive, hearing, vision, and dental services, with specific copays, coinsurance, and maximum benefits for each. Additional benefits include home health services with no copay, ambulance services with a $240 copay, and coverage for home infusion and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but require prior authorization. For days 1-4, there is a $175 copay, and for days 5-90, there is no copay. Additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services, are covered. Outpatient Hospital Services have a copay of $40-$200, Observation Services have a $400 copay, Ambulatory Surgical Center (ASC) Services have a $300 copay, and Individual and Group Sessions for Outpatient Substance Abuse both have a copay of $40. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Align ChoicePlus (PPO) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Align ChoicePlus (PPO) plan. Ground and Air Ambulance Services have a copay of $240, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Align ChoicePlus (PPO) plan. Emergency Services have a $90 copay and no coinsurance, and Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $250.
Primary Care See details
The Align ChoicePlus (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a copay between $0 and $50. Podiatry services have a $30-$40 copay and 20% coinsurance for routine foot care, while physical therapy and speech-language pathology services have a $40 copay. The plan also covers additional telehealth benefits and opioid treatment program services. However, individual and group sessions for mental health specialty services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services and annual physical exams, are covered. Additional preventive services include Fitness Benefit with a $5 copay. Other services like In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
The Align ChoicePlus (PPO) plan covers hearing exams and prescription hearing aids, but fitting/evaluation for hearing aids, inner ear hearing aids, outer ear hearing aids, over the ear hearing aids, and OTC hearing aids are not covered. Routine hearing exams are covered once per year. Prescription hearing aids have a maximum benefit of $1000 every year.
Vision Services See details
Vision Services include eye exams with a 20% coinsurance and eyewear with a combined maximum benefit of $100 every year, including contact lenses and eyeglasses. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered, including oral exams (2 per year), dental x-rays (1 bitewing x-ray per year, 1 full mouth x-ray every 5 years), prophylaxis (cleaning) (2 per year), restorative services (1 every two years), endodontics (1 root canal therapy per lifetime), periodontics (1 every three years), prosthodontics, removable (1 oral surgery or crown per lifetime), maxillofacial prosthetics (1 oral surgery or crown per lifetime), prosthodontics, fixed (1 oral surgery or crown per lifetime), and oral and maxillofacial surgery (1 oral surgery or crown per lifetime), but fluoride treatment, implant services, and orthodontics are not covered. Orthodontic services have a maximum benefit of $750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, which has a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs, which has a $100 copay and 0-20% coinsurance. Other Medicare Part B Drugs are covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Align ChoicePlus (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance. Durable medical equipment for use outside the home and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, though Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $375, and Therapeutic Radiological Services have a 20% coinsurance, while Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Align ChoicePlus (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Align ChoicePlus (PPO) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the cost-sharing details are not provided in the snippet. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $70 every three months, and a meal benefit with a doctor referral required. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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